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If you’re pregnant lock yourself in the house, shut the curtains and wear a facemask if you so much as put your nose outside the door… has advice to pregnant women finally gone too far? Or, given that at least six healthy women in their second and third trimesters of pregnancy are reported to be in intensive care with pandemic flu in Australia is this reasonable advice?

The difficulty is that as yet we don’t know enough about the behaviour of the new H1N1 flu virus. This lack of information creates a vacuum that gets filled with a cacophony of conflicting expert advice that gets amplified through our pervasive media systems.

The latest flurry of advice to pregnant women is at best confusing and at worst completely impractical and non evidence-based. According to guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) pregnant women should avoid “unnecessary travel”. So what exactly constitutes unnecessary travel? How many pregnant women set off each morning on spurious jaunts to the seaside, frivolous journeys to work, or perhaps decide that today is the day to sample their local bus routes for kicks?

The Royal College of Midwives advise that pregnant women should “avoid crowded places when possible”. Again, I’m not quite sure how women are meant to do that. Perhaps now is the time to switch from travelling to work on the underground and finally hire a chauffeur (one that’s already had swine flu preferably) to keep you away from the virus-breathing hordes? Or, is this the perfect excuse for pregnant women to create a domestic dictatorship and sit at home loftily issuing instructions to every family member as they are committed to self-incarceration?

In Australian media reports, the president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is quoted as advising that pregnant women should wear masks in crowded places, especially if they also have asthma and are overweight. This is not evidence-based advice, as simple facemasks do not protect people from catching flu. Is this a matter of media misquoting or is that really what the RANZCOG advise?

The bottom line is that hand and respiratory hygiene measures are the best ways to reduce the risk of H1N1 flu in pregnancy. The conflicting messages about masks and staying at home dilute the key messages to everyone about hand washing, sneezing and disposing of tissues. So, perhaps when leaving the house, pregnant women would be better advised to take some soap or alcohol hand gel with them, rather than a facemask, and use it to clean their hands regularly.

Annabel Bentley (MBBS FRCS) is interested in evidence that matters to patients and health risk communication. Originally trained as a surgeon, she is now assistant medical director at Bupa. The views in this blog is her own and not of any organisation she works for.

Over one month (15April – 18May 2009) there were:
* 34 confirmed/probable cases of H1N1 flu in pregnant women in USA
* 14 of these 34 women were admitted to hospital (11 were for >24 hours)

Over two months (15April – 16June 2009) there were:
* 45 deaths from H1N1 flu in USA population
* of these, 6 deaths (13%) were in pregnant women, most in the third trimester

Around 1% of USA population are estimated to be pregnant at any one time
* but pregnant women represent approx 13% of the H1N1 deaths in USA
* NB: note that there are very limited data and other limitations in the Lancet paper, so it is too early to interpret the precise impact of pregnancy on H1N1 flu.

Key concluding message from the Lancet authors is that pregnant women with H1N1 flu should be treated promptly with antivirals.

Marcy Lee

The RCOG and RCM Advisory was signed off by the DH so is the government line. Maybe you should read the DH’s pandemic influenza guidance on preparing maternity services. On page 17 that says that pregnant women should avoid conception.

Matt Williams

@Marcy Lee – I didn’t realise that pregnant women could conceive…

Page 17 of the DH advisory says: “…it may be sensible to advise normally healthy women trying for children to consider delaying conception”.